Lothian Diabetes Handbook MANAGEMENT OF DIABETIC KETOACIDOSIS
|
|
- Jody Hardy
- 7 years ago
- Views:
Transcription
1 MANAGEMENT OF DIABETIC KETOACIDOSIS 90
2 MANAGEMENT OF DIABETIC KETOACIDOSIS Diagnosis elevated plasma and/or urinary ketones metabolic acidosis (raised H + /low serum bicarbonate) Remember that hyperglycaemia, although usually marked, is not a reliable guide to the severity of acidosis, and in children, pregnant women, malnourished or alcoholic patients, blood glucose may not be very raised. The degree of hyperglycaemia is not a reliable guide to the severity of the metabolic disturbance in DKA. The presence of the following features should alert you to the possibility of DKA: intra and extra-vascular volume depletion with reduced skin turgor, tachycardia and hypotension (late features) rapid and deep sighing respirations, smell of ketones ketonuria vomiting/abdominal pain drowsiness/reduced conscious level Consider DKA in any unconscious or hyperventilating patient. Remember: Consider DKA in any unconscious or hyperventilating patient. Patients with adverse clinical signs (on the SEWS chart) or signs of cerebral oedema (see below) should be discussed immediately with senior medical staff. These guidelines refer to adult patients. All patients under the age of 16 should be discussed with the paediatric diabetes team at the Sick Children s hospital and arrangements made for transfer when clinically appropriate. Immediate management Within the First Hour Initial Assessment Airway and breathing - correct hypoxaemia. IV access. monitor ECG, O 2 saturations, pulse, BP, respiratory rate, conscious level and fluid balance. Laboratory blood glucose, bedside BM, urea and electrolytes, serum bicarbonate, arterial blood gases. 91
3 Fluid Replacement Commence rehydration with 0.9% saline 1000 ml over one hour. Intravenous Insulin Prepare intravenous insulin infusion (see below) and commence at 3 units/hr Other Interventions/Actions NG tube if impaired consciousness or protracted vomiting. Catheter if oliguric. Consider central line if clinically indicated. Admits patient to a high dependency area. Call the metabolic/diabetes registrar. Ongoing management Hours 2-4 Reassess patient regularly and monitor vital signs Intravenous fluids Aim to rapidly restore circulating volume and then gradually correct interstitial and intracellular fluid deficits. Use isotonic saline (see example below) infusion rates will vary between patients, remember risk of cardiac failure in elderly patients. If hypotension (SBP < 100 mmhg) or signs of poor organ perfusion are present, use colloid to restore circulating volume. 1000mls 0.9% saline over 2 nd hour 500mls 0.9% saline over 3 rd hour 500mls 0.9% saline over 4 th hour Add in 10% dextrose once blood glucose <14 mmol/l. Infuse at 100mls/hr. Do not alternate saline and dextrose. Measure U&Es and venous bicarbonate at the end of hour 2 and hour 4. Electrolyte replacement Despite a considerable total body potassium deficit ( mmol/l), plasma potassium levels are usually normal or high at presentation, because of acidosis, insulin deficiency and renal impairment. Potassium concentration will fall following commencement of treatment; expect to give plenty of potassium. Target potassium concentration is mmol/l. Severe hypokalaemia complicating treatment of DKA is potentially fatal and is usually avoidable. 92
4 Blood Glucose and Insulin Hourly laboratory glucose Aim to ensure a gradual reduction in blood glucose over the first hours. There is no specific evidence to avoid rapid rates of fall (e.g. >5mmol/hr), but there are some observational data to suggest that excessive rates of fall may be associated with cerebral oedema. The target blood glucose concentration for the end of the first day is 10-20mmol/l. Make up an infusion of 50 units of soluble insulin (e.g. Humulin S or Actrapid) in 50 mls 0.9% saline (1 unit/ml) and infuse using a syringe driver. Aim for a gradual reduction in blood glucose over 12 hours 6 units/hr initially 3-4 units/hr when blood glucose < 14 mmol/l If plasma glucose does not fall in the first hour, the rate of infusion needs increased - phone the metabolic registrar and/or senior medical staff for advice If blood glucose falls below target (i.e. <9mmol/l) on 3 units/hr, reduce insulin infusion to 2 units/hr. Do not reduce the insulin rate below this. If glucose continues to fall, increase the infusion rate of dextrose or the concentration. Discuss with the diabetes registrar and/or senior medical staff. Remember that intravenous insulin has a half-life of 2.5 minutes. It is important that the insulin infusion is not interrupted. Consider Precipitating Factors If indicated check: FBC CXR ECG Urine gram stain and culture Blood cultures and other infection screen Correction of acidosis Volume resuscitation and insulin infusion will correct metabolic acidosis in the majority. Ketonaemia typically takes longer to clear than hyperglycaemia. Intravenous sodium bicarbonate should not be used routinely and certainly not without discussing with a senior doctor (there is evidence it may cause harm if there is evidence of cardiogenic shock or other lactate-generating conditions). Other measures Urinary catheter: if cardiac failure, persistent hypotension, renal failure or no urine passed after 2 hours. CVP line: consider if elderly with concomitant illness, cardiac failure or renal failure. Give standard venous thromboembolism prophylaxis. Antibiotics: only if infection is proven or strongly suspected. Remember that raised WBC and fever occur with metabolic acidosis. Screen for myocardial infarction if > 40 years old Subsequent Management 4 hours+ Fluids and Electrolytes Allow oral intake if swallowing safe and bowel sounds present. 93
5 Measure U&Es and venous bicarbonate twice daily, until bicarbonate within the normal reference range. Continue with 0.9% saline <250ml/hour until bicarbonate is in the reference range and the patient is eating. Continue potassium infusion until target is maintained. Insulin and Dextrose A blood glucose meter can be used to monitor blood glucose concentration if the previous laboratory blood glucose is <20mmol/l. Pre-meal subcutaneous insulin should be administered to patients who are eating, even when on intravenous insulin. Discuss the doses with the diabetes registrar. Maintain IV insulin (minimum rate 2 units/her) and 10% dextrose infusion (100ml/hr) until biochemically stable and patient has eaten at least two meals. In such circumstances, stop IV insulin 30 minutes after subcutaneous insulin. Continuing Care Ensure patient is reviewed by the diabetes team on the day following admission (at the very latest), so that the cause of the DKA can be elucidated, appropriate education can be given and follow up arranged. Patient should not be discharged until biochemically normal, eating normally and established on subcutaneous insulin. Ensure that a copy of the discharge summary is sent to the diabetes team. Acute complications Hypokalaemia: due to inadequate potassium replacement and predictable due to insulin and fluid administration and resolution of acidosis. Avoid by regular monitoring of electrolytes and appropriate potassium replacement. Hypoglycaemia: due to overzealous treatment with insulin. Hyperglycaemia: due to interruption or discontinuance of intravenous insulin after recovery without subsequent coverage by subcutaneous insulin always ask advice of metabolic registrar. Cerebral oedema: rare but potentially fatal. More common in children, but is seen in young adults. Characteristically, the patient has initially responded well to treatment prior to the development of severe headache and neurological deterioration. Get urgent senior help. Treatment is with mannitol g/kg body weight. ARDS: suspect if dyspnoea, tachypnoea, central cyanosis and non-specific chest signs. Manage on ITU. Thromboembolism presentation and management as standard. Potassium replacement No potassium in the first litre unless known to be < 3.0 mmol/l Thereafter, replace potassium as below: plasma potassium (mmol/l) potassium added (mmol/hr) < * >5.0, or anuric No supplements * must be given in one litre of fluid; avoid infusion rates of KCL >10 mmol/hr Protocol prepared by Vincent McAulay 10/2002 Updated by Mark Strachan 5/
Hyperosmolar Non-Ketotic Diabetic State (HONK)
Hyperosmolar Non-Ketotic Diabetic State (HONK) University Hospitals of Leicester NHS Trust Guidelines for Management of Acute Medical Emergencies Management is largely the same as for diabetic ketoacidosis
More informationNICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.
Diabetic ketoacidosis in children and young people bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They
More informationDiabetic Ketoacidosis
Princess Margaret Hospital for Children PAEDIATRIC ACUTE CARE GUIDELINE Diabetic Ketoacidosis Scope (Staff): Scope (Area): All Emergency Department Clinicians Emergency Department This document should
More informationUniversity of Gezira. Faculty of Medicine. Department of Paediatrics and Child Health. Integrated Management of Diabetes in Children (IMDC) Project
University of Gezira Faculty of Medicine Department of Paediatrics and Child Health Integrated Management of Diabetes in Children (IMDC) Project Guidelines for Diabetes Management in Children 2007 1 These
More informationINTRAVENOUS FLUIDS. Acknowledgement. Background. Starship Children s Health Clinical Guideline
Acknowledgements Background Well child with normal hydration Unwell children (+/- abnormal hydration Maintenance Deficit Ongoing losses (e.g. from drains) Which fluid? Monitoring Special Fluids Post-operative
More informationONCE ONLY GLUCAGON and Fast Acting Glucose gel (PGD) For nurse administration under Patient Group Direction (Trust wide PGD in place)
ADULT INSULIN PRERIPTION AND BLOOD GLUCOSE MONITORING CHART Ward CONSULTANT DATE OF ADMISSION Please affix Patient s label here Ward Ward.../...year PATIENT NAME....... DATE OF BIRTH... NHS NUMBER.......
More informationHyperglycaemic Hyperosmolar States in Diabetes: Guidelines on Diabetic Ketoacidosis (DKA) and Hyperosmolar Non-ketotic Hyperglycaemia (HONK)
Hyperglycaemic Hyperosmolar States in Diabetes: Guidelines on Diabetic Ketoacidosis (DKA) and Hyperosmolar Non-ketotic Hyperglycaemia (HONK) Contents: Introduction...2 Diabetic Ketoacidosis...2 Presentation...3
More informationGuidelines for the Management of Diabetic Ketoacidosis (DKA) in Adults Inpatient Diabetes Steering Group
Guidelines for the Management of Diabetic Ketoacidosis (DKA) in Adults Inpatient Diabetes Steering Group 1. Introduction 1.1 This document sets out the guidelines for the management of Diabetic Ketoacidosis
More informationBSPED Recommended Guideline for the Management of Children and Young People under the age of 18 years with Diabetic Ketoacidosis 2015
BSPED Recommended Guideline for the Management of Children and Young People under the age of 18 years with Diabetic Ketoacidosis 2015 These guidelines for the management of DKA in children and young people
More informationDAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES
One Children s Plaza Dayton, OH 45404-1815 www.childrensdayton.org DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended
More informationMind the Gap: Navigating the Underground World of DKA. Objectives. Back That Train Up! 9/26/2014
Mind the Gap: Navigating the Underground World of DKA Christina Canfield, MSN, RN, ACNS-BC, CCRN Clinical Nurse Specialist Cleveland Clinic Respiratory Institute Objectives Upon completion of this activity
More informationChildren and Young People with Diabetic Ketoacidosis (DKA)
NHS No: Name: Address: Date of Birth: CR No: Affix patient label Children and Young People with Diabetic Ketoacidosis (DKA) Admission Date: Admission Source: Admission Time: Time patient first seen in
More informationSouthwest Paediatric Diabetes Regional Network Integrated Care Pathway for Children and Young People with Diabetic Ketoacidosis
Date Additional Information Signature Name: Date of Birth: DD /MM /YYYY Hospital Number: NHS Number: (or affix hospital label here) Southwest Paediatric Diabetes Regional Network Integrated Care Pathway
More informationDiabetic Ketoacidosis: When Sugar Isn t Sweet!!!
Diabetic Ketoacidosis: When Sugar Isn t Sweet!!! W Ricks Hanna Jr MD Assistant Professor of Pediatrics University of Tennessee Health Science Center LeBonheur Children s Hospital Introduction Diabetes
More informationElectronic copy to all appropriate staff Intranet Notification in Staff Focus Related Trust Policies (to be read in conjunction with)
Diabetes Management for Children and Young People undergoing Surgery (0-16 yrs) Clinical Guideline Register No: 10096 Status: Public Developed in response to: Updated national guidelines Contributes to
More informationRGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND
RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND Monitor patient on the ward to detect trends in vital signs and to manage accordingly To recognise deteriorating trends and request relevant medical/out
More informationGESTATIONAL DIABETES (DIET/INSULIN/METFORMIN) CARE OF WOMEN IN BIRTHING SUITE
GESTATIONAL DIABETES (DIET/INSULIN/METFORMIN) CARE OF WOMEN IN BIRTHING SUITE DEFINITION A disorder characterised by hyperglycaemia first recognised during pregnancy due to increased insulin resistance
More informationDehydration & Overhydration. Waseem Jerjes
Dehydration & Overhydration Waseem Jerjes Dehydration 3 Major Types Isotonic - Fluid has the same osmolarity as plasma Hypotonic -Fluid has fewer solutes than plasma Hypertonic-Fluid has more solutes than
More informationDiabetic Emergencies. David Hill, D.O.
Diabetic Emergencies David Hill, D.O. Class Outline Diabetic emergency/glucometer training Identify the different signs of insulin shock Diabetic coma, and HHNK Participants will understand the treatment
More informationPaediatric fluids 13/06/05
Dr Catharine Wilson Consultant Paediatric Anaesthetist Sheffield Children s Hospital. UK Paediatric fluids 13/06/05 Self assessment: Complete these questions before reading the tutorial. Discuss the answers
More informationGuidelines. for Sick Day Management for People with Diabetes
Guidelines for Sick Day Management for People with Diabetes When to Follow Sick Day Guidelines These guidelines apply when the person with diabetes is feeling unwell or noticing signs of an illness and/
More informationTYPE 1 DIABETES - SICK DAY RULES
TYPE 1 DIABETES - SICK DAY RULES Information Leaflet Your Health. Our Priority. Page 2 of 6 Introduction People with diabetes don t get ill any more often than other people, but illness and infections
More informationPaediatric Management of Diabetic Ketoacidosis (DKA) Guideline No: 13
Ketoacidosis (DKA) Guideline No: 13 Page 1 of 12 IMMEDIATE ASSESSMENT Clinical History Polyuria / enuresis Polydipsia Weight loss (Weigh) Abdominal pain Tiredness Vomiting Confusion Clinical Signs Dehydration
More informationTYPE 2 DIABETES MELLITIS (INSULIN AND/OR METFORMIN) CARE OF WOMEN IN BIRTHING SUITE
TYPE 2 DIABETES MELLITIS (INSULIN AND/OR METFORMIN) CARE OF WOMEN IN BIRTHING SUITE DEFINITION Type 2 Diabetes is characterised by insulin resistance and relative impairment of insulin secretion leading
More informationNICE guideline Published: 9 December 2015 nice.org.uk/guidance/ng29
Intravenous fluid therapy in children and young people in hospital NICE guideline Published: 9 December 2015 nice.org.uk/guidance/ng29 NICE 2015. All rights reserved. Contents Key priorities for implementation...
More informationThe early symptoms of acute salicylism are the triad of gastrointestinal distress, tinnitus or altered hearing, and hyperventilation.
POISONING SALICYLATES (ASPIRIN) Management Guidelines Emergency Department Princess Margaret Hospital for Children Perth, Western Australia Last reviewed: January 2007 Page 1 of 5 Dr Gary Geelhoed Dr Frank
More informationEarly Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi
Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi What is EWS? After qualifying, junior doctors are expected to distinguish between the moderately sick patients who can be managed in the
More informationPeri-Operative Guidelines for Management of Diabetes Patients
Peri-Operative Guidelines for Management of Diabetes Patients Target blood glucose 6-10 mmol/l for all patients Acceptable blood glucose 4-11 mmol/l for all patients Definitions Non-Insulin Glucose Lowering
More informationManagement of Children with newly diagnosed type 1 diabetes (up until their 18th Birthday)
Title: Author: Speciality / Division: Directorate: CLINICAL GUIDELINES ID TAG Management of Children with newly diagnosed type 1 diabetes (up until their 18th Birthday) Dr Teresa Mulroe and Dr Sarinda
More informationSurgery and Procedures in Patients with Diabetes
Surgery and Procedures in Patients with Diabetes University Hospitals of Leicester NHS Trust DEFINITIONS Minor Surgery and Procedures: expected to be awake, eating and drinking by the next meal, total
More informationKetones & diabetes; Reduce your risk!
Ketones & diabetes; Reduce your risk! Booklet includes Sick Day Wallet Card Ketones 101 Do I really need to know this? by Helen Jones RN, MSN, CSE YES! The word Ketone is important for you to know if you
More informationCase Study. Objectives
Case Study One in a series of case studies developed to stimulate enhancement of problem-solving techniques for physicians and nurses and paramedical personnel when challenged by patients who present with
More informationHow To Treat A Heart Attack
13 Resuscitation and preparation for anaesthesia and surgery Key Points 13.1 MANAGEMENT OF EMERGENCIES AND CARDIOPULMONARY RESUSCITATION ESSENTIAL HEALTH TECHNOLOGIES The emergency measures that are familiar
More informationKetones and Ketoacidosis
Ketones and Ketoacidosis If you have diabetes and become unwell or have high blood glucose levels of 14 mmol/l or more please check for ketones If the body does not have enough insulin its energy levels
More informationACID- BASE and ELECTROLYTE BALANCE. MGHS School of EMT-Paramedic Program 2011
ACID- BASE and ELECTROLYTE BALANCE MGHS School of EMT-Paramedic Program 2011 ACID- BASE BALANCE Ions balance themselves like a see-saw. Solutions turn into acids when concentration of hydrogen ions rises
More informationPOAC CLINICAL GUIDELINE
POAC CLINICAL GUIDELINE Acute Pylonephritis DIAGNOSIS COMPLICATED PYELONEPHRITIS EXCLUSION CRITERIA: Male Known or suspected renal impairment (egfr < 60) Abnormality of renal tract Known or suspected renal
More informationManagement of Diabetes Mellitus in Custody
Recommendations The medico-legal guidelines and recommendations published by the Faculty are for general information only. Appropriate specific advice should be sought from your medical defence organisation
More informationUniversity College Hospital. Sick day rules insulin pump therapy
University College Hospital Sick day rules insulin pump therapy Children and Young People s Diabetes Service Children whose diabetes is well controlled should not experience more illness or infections
More informationInsulin Treatment. J A O Hare. www.3bv.org. Bones, Brains & Blood Vessels
Insulin Treatment J A O Hare www.3bv.org Bones, Brains & Blood Vessels Indications for Insulin Treatment Diabetic Ketoacidosis Diabetics with unstable acute illness ICU Gestational Diabetes: diet failure
More informationAcute heart failure may be de novo or it may be a decompensation of chronic heart failure.
Management of Acute Left Ventricular Failure Acute left ventricular failure presents as pulmonary oedema due to increased pressure in the pulmonary capillaries. It is important to realise though that left
More information[ ] POCT glucose Routine, As needed, If long acting insulin is given and patient NPO, do POCT glucose every 2 hours until patient eats.
Glycemic Control - Insulin Infusion NOTE: For treatment of Diabetic Ketoacidosis or Hyperglycemic Hyperosmolar Syndrome please go to order set named Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar
More informationGUIDANCE FOR INTRAVENOUS FLUID AND ELECTROLYTE PRESCRIPTION IN ADULTS
NHS NHS Lothian GUIDANCE FOR INTRAVENOUS FLUID AND ELECTROLYTE PRESCRIPTION IN ADULTS Fluid prescriptions are very important. Prescribing the wrong type or amount of fluid can do serious harm. Assessment
More informationFeeling sick? What to do. Information for people with Type 1 Diabetes
Feeling sick? What to do Information for people with Type 1 Diabetes Diabetes and sick days A minor illness can result in a major rise in blood glucose levels Common illnesses such as tonsillitis, ear,
More informationCARDIAC SURGERY INTRAVENOUS INSULIN PROTOCOL PHYSICIAN ORDERS INDICATIONS EXCLUSIONS. Insulin allergy
Page 1 of 5 INDICATIONS EXCLUSIONS 2 consecutive blood glucose measurements greater than 110 mg per dl AND NPO with a continuous caloric source AND Diagnosis of : Cardio-thoracic Surgery NOTE: This protocol
More informationLaboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition
Laboratory Monitoring of Adult Hospital Patients Receiving Parenteral Nutrition Copy 1 Location of copies Web based only The following guideline is for use by medical staff caring for the patient and members
More informationIntravenous Therapy. Marjorie Wiltshire, RN
Intravenous Therapy Marjorie Wiltshire, RN :OBJECTIVES Define key terms related to intravenous therapy. Demonstrate the procedure for IV insertion, conversion to a saline lock, administration of IV fluids,
More informationAdult CCRN/CCRN E/CCRN K Certification Review Course: Endocrine 12/2015. Endocrine 1. Disclosures. Nothing to disclose
Adult CCRN/CCRN E/CCRN K Certification Review Course: Carol Rauen RN BC, MS, PCCN, CCRN, CEN Disclosures Nothing to disclose 1 Body Harmony disorders and emergencies Body Harmony (cont) Introduction Disorders
More informationDOCUMENT CONTROL PAGE
DOCUMENT CONTROL PAGE Document Number: GUI/CL/WCN/666 Version Number: Version 2 Title: Guidelines for the management of inpatient diabetes, including the management of diabetic emergencies and the management
More information3 Which fluid and why?
3 Which fluid and why? Key points Blood products, colloids and crystalloids are the three main fluid types used in veterinary practice Blood transfusion requires a suitable donor and checks for compatibility
More informationMy Sick Day Plan for Type 1 Diabetes on an Insulin Pump
My Sick Day Plan for Type 1 Diabetes on an Insulin Pump When you are sick, your blood sugar levels may be harder to keep under control. Your blood sugar may go too high or too low. Use this guide to help
More informationClinical Guideline Diabetes management during surgery (adults)
Clinical Guideline Diabetes management during surgery (adults) Standard 8 of the National Service Framework for Diabetes states that all children, young people and adults with diabetes admitted to hospital,
More informationLung Pathway Group Pemetrexed and Cisplatin in Non-Small Cell Lung Cancer (NSCLC)
Indication: NICE TA181 First line treatment option in advanced or metastatic non-squamous NSCLC (histology confirmed as adenocarcinoma or large cell carcinoma) Performance status 0-1 Regimen details: Pemetrexed
More informationROYAL HOSPITAL FOR WOMEN
ROYAL HOSPITAL FOR WOMEN LOCAL OPERATING PROCEDURE CLINICAL POLICIES, PROCEDURES & GUIDELINES Approved by Quality & Patient Safety Committee 17 April 2014 INSULIN INFUSION PROTOCOL INSULIN DEXTROSE INFUSION
More information2011 EBM-hyperglycemia
嗎 2011 EBM-hyperglycemia 陳 莉 瑋 醫 師 一 定 要 打 打 bolus insulin? 用 FinePrint 列 印 - 可 在 www.ahasoft.com.tw/fineprint 訂 購 Question 1 Is bolus insulin necessary in DKA? P:DKA adult patient I:initial bolus insulin+insulin
More informationDehydration and Fluid Therapy Guide
Dehydration and Fluid Therapy Guide Background: Dehydration occurs when the loss of body fluids (mainly water) exceeds the amount taken in. Fluid loss can be caused by numerous factors such as: fever,
More informationContinuous Subcutaneous Insulin Infusion (CSII) pump therapy
Continuous Subcutaneous Insulin Infusion (CSII) pump therapy GHPI1267_04_15 Department: Diabetes team Review due: April 2018 www.gloshospitals.nhs.uk 21 BETTER FOR YOU BETTER FOR YOU 1 Introduction This
More informationUser guide Basal-bolus Insulin Dosing Chart: Adult
Contacts and further information Local contact Clinical pharmacy or visiting pharmacy Diabetes education service Director of Medical Services Visiting or local endocrinologist or diabetes physician For
More information!!! BOLUS DOSE IV. Use 5-10 mcg IV boluses STD ADRENALINE INFUSION. Use IM adrenaline in advance of IV dosing!
ADRENALINE IVI BOLUS IV Open a vial of 1:1000 ADRENALINE 1 mg /ml Add 1 ml to 9 ml N/Saline = 1mg adrenaline in 10 ml (or 100 mcg/ml) Add 1 ml 1:10,000 to 9 ml N/Saline = 100 mcg adrenaline in 10 ml (or
More informationHydration Protocol for Cisplatin Chemotherapy
Betsi Cadwaladr University Health Version: 1.3 CSPM2 Hydration Protocol for Cisplatin Chemotherapy Date to be reviewed: July 2018 No of pages: 9 Author(s): Tracy Parry-Jones Author(s) title: Lead Cancer
More informationInsulin Pump Therapy
CHILDREN S SERVICES Insulin Pump Therapy These guidelines are not intended for starting a patient on an insulin pump. They are intended to give staff not part of the diabetic team information regarding
More informationINR: RUPTURED ANEURYSM: POST EMBOLIZATION Patient Identification Page 1 of 5. Allergies: Weight: kg Diagnosis:
Page 1 of 5 Allergies: Weight: kg Diagnosis: Service: Admission Admit to Inpatient Admit to Daypatient Place on Outpatient Observation Status Hospital Attending: Attending Physician Attending Provider:
More informationPostoperative management in adults
Scottish Intercollegiate Guidelines Net work 77 Postoperative management in adults A practical guide to postoperative care for clinical staff 1 Introduction 1 2 Clinical assessment and monitoring 3 3 Cardiovascular
More informationGuidelines for Sick Day Management for People with Diabetes
Guidelines for Sick Day Management for People with Diabetes Technical Review Document Australian Diabetes Educators Association Australian Diabetes Educators Association August 2006 The Australian Diabetes
More informationInsulin Pump Therapy during Pregnancy and Birth
Approvals: Specialist Group: Miss F Ashworth, Dr I Gallen, Dr J Ahmed Maternity Guidelines Group: V1 Dec 2012 Directorate Board: V1 Jan 2013 Clinical Guidelines Subgroup: July 2011 MSLC: V1 Nov 2012 Equality
More informationAcute Care Day Respiratory. SCENARIO The Patient with Acute Asthma
Acute Care Day Respiratory SCENARIO The Patient with Acute Asthma Notes for the instructor not volunteered to students 30 minutes have been allocated to the running of the scenario with an additional 10
More informationDiabetes Hypoglycemia/Hyperglycemia Reaction
Diabetes Hypoglycemia/Hyperglycemia Reaction Hypoglycemic Reaction (Insulin Shock) A. Hypoglycemic reactions (insulin reactions) should be treated according to current nursing and medical recommendations.
More information2002 burns responsible for 322,000 deaths world wide. aboriginal community in NA Most burns occur in the urban environment
Burn Injuries: The Problem 2002 burns responsible for 322,000 deaths world wide 4 th as cause of unintentional child injury death in the USA 3 rd leading cause of unintentional death in aboriginal community
More informationEFFIMET 1000 XR Metformin Hydrochloride extended release tablet
BRAND NAME: Effimet XR. THERAPEUTIC CATEGORY: Anti-Diabetic PHARMACOLOGIC CLASS: Biguanides EFFIMET 1000 XR Metformin Hydrochloride extended release tablet COMPOSITION AND PRESENTATION Composition Each
More informationReducing Insulin Related Errors in Patients Treated for Hyperkalemia
Reducing Insulin Related Errors in Patients Treated for Hyperkalemia Tan Tock Seng Hospital is an acute care general hospital with a 1,200 bed capacity The hospital addressed the problem of insulinrelated
More informationDengue Update: WHO 2009 Guideline
Dengue Update: WHO 2009 Guideline Ma. Rosario Z. Capeding, MD Research Institute for Tropical Medicine Global Burden of Dengue 1.8 Billion or >70% of the population at risk for dengue worldwide live in
More informationInpatient Guidelines: Insulin Infusion Pump Management
Inpatient Guidelines: Insulin Infusion Pump Management Developed by the Statewide Diabetes Clinical Network Steering Committee July 2012 Clinical Access and Redesign Unit Table of Contents Purpose...4
More informationGuideline for the Management of Nephrotic Syndrome
Guideline for the Management of Nephrotic Syndrome Renal Unit Royal Hospital for Sick Children Yorkhill Division Please note: the following guideline has not been assessed according to the AGREE (Appraisal
More informationCore Measures SEPSIS UPDATES
Patricia Walker, RN-BC, BSN Evidence Based Practice Manager Quality Management Services UCLA Health System, Ronald Reagan Medical Center Core Measures SEPSIS UPDATES Sepsis Core Measures Bundle Requirements
More informationJeopardy Topics: THE CLOT STOPS HERE (anticoagulants) SUGAR, SUGAR, HOW D YOU GET SO HIGH (insulins)
Jeopardy Topics: THE CLOT STOPS HERE (anticoagulants) SUGAR, SUGAR, HOW D YOU GET SO HIGH (insulins) I HEAR YA KNOCKING BUT YOU CAN T COME IN (electrolytes) TAKE MY BREATH AWAY (Opiates-morphine) OUT WITH
More informationAcid-Base Balance and the Anion Gap
Acid-Base Balance and the Anion Gap 1. The body strives for electrical neutrality. a. Cations = Anions b. One of the cations is very special, H +, and its concentration is monitored and regulated very
More informationAdvanced Practice Provider Academy
(+)Corey M. Slovis, MD, FACEP Professor, Emergency Medicine and Medicine; Chairman, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Medical Director, Metro
More informationAcid/Base Homeostasis (Part 4)
Acid/Base Homeostasis (Part 4) Graphics are used with permission of: Pearson Education Inc., publishing as Benjamin Cummings (http://www.aw-bc.com) 5. The newly formed bicarbonate moves into the plasma.
More informationBlood Glucose Management
Blood Glucose Management What Influences Blood Sugar Levels? There are three main things that influence your blood sugar: Nutrition Exercise Medication What Influences Blood Sugar Levels? NUTRITION 4 Meal
More informationGuideline for the Management of Acute Hyperkalaemia in Adults
Guideline for the Management of Acute Hyperkalaemia in Adults Author Directorate & Speciality Updated by John Gell (Clinical Pharmacist) Diagnostics and Clinical Support Date of submission April 2013 Date
More informationCLINICAL SKILLS: THE 'DR ABCDE' ASSESSMENT
CLINICAL SKILLS: THE 'DR ABCDE' ASSESSMENT The 'DR ABCDE' approach to assessing an acutely unwell patient should be at the front of every junior doctor's mind whenever they get bleeped or asked to see
More informationGlycaemic Control in Adults with Type 1 Diabetes
Glycaemic Control in Adults with Type 1 Diabetes Aim(s) and objective(s) This document aims to provide guidance on good clinical practice in managing glycaemic control in adult patients with Type 1 Diabetes
More informationOxygen Therapy. Oxygen therapy quick guide V3 July 2012.
PRESENTATION Oxygen (O 2 ) is a gas provided in a compressed form in a cylinder. It is also available in a liquid form. It is fed via a regulator and flow meter to the patient by means of plastic tubing
More informationEileen Whitehead 2010 East Lancashire HC NHS Trust
Eileen Whitehead 2010 East Lancashire HC NHS Trust 1 Introduction: Arterial blood gas analysis is an essential part of diagnosing and managing a patient s oxygenation status and acid-base balance However,
More informationBeaumont Hospital Department of Nephrology and Renal Nursing. Guideline for administering Ferinject
Beaumont Hospital Department of Nephrology and Renal Nursing Guideline Name: Guideline for administering Ferinject Guideline Number: 18 Guideline Version: a Developed By: Louise Kelly CNM 1 Renal Day Care
More informationPaediatric Advanced Warning Score (PAWS)
Paediatric Advanced Warning Score (PAWS) Prevention is better than cure. Spectrum of critical illness Ward level care HDU Care ICU Care Early admission may improve outcome ICU Outreach teams Medical Emergency
More informationNSW Adult Subcutaneous Insulin Prescribing Chart User Guide
NSW Adult Subcutaneous Insulin Prescribing Chart User Guide Adult Subcutaneous Insulin Prescribing Chart User Guide - 13 August 2013 Contents Target audience:... 1 Exceptions:... 1 1. Introduction... 2
More informationGuidelines update: diabetes mellitus. Emergency MANAGEMENT
tlaleletso DM GUIDELINES UPDATE April 2012, Issue 4 Guidelines update: diabetes mellitus The number of people living with diabetes is increasing globally. The WHO estimates that by 2030, 366 million worldwide
More informationCRRT: I and O. I and O Sheet
CRRT: I and O I and O Sheet The following slide outlines a 12 hour CRRT I and O record. The individual lines of the I and O portion of the record will be reviewed. At the end of each hour, the ICU nurse
More informationDiabetes Information
Diabetes Information Your diabetes team includes: Consultant Paediatric Endocrinologist Paediatric Diabetes Clinical Nurse Specialists Senior Clinical Nutritionists/Dietitians Senior Clinical Psychologist
More informationReview Group: Mental Health Operational Medicines Management Group. Signature Signature Signature. Review Date: December 2014
Mental Health NHS Grampian Mental Health Service Staff Guidance For The Prescribing Of Vitamin Supplementation During In-Patient Admission (Mental Health) For Alcohol Withdrawal Co-ordinators: Consultant
More informationSARASOTA MEMORIAL HOSPITAL
SARASOTA MEMORIAL HOSPITAL TITLE: NURSING PROCEDURE CARE OF THE INTRAPARTUM PATIENT RECEIVING CONTINUOUS INTRAVENOUS INSULIN ADMINISTRATION (obs25) DATE: REVIEWED: PAGES: 9/93 8/15 1 of 7 PS1094 ISSUED
More informationSection Contents Page 2.1 2 2.2. Contact Details. General Principles
CLINICAL GUIDELINE FOR THE MANAGEMENT OF PAEDIATRIC PATIENTS WITH DIABETES TYPE 1 AND 2 REQUIRING A GENERAL ANAESTHETIC OR SEDATION FOR SURGERY OR ANOTHER PROCEDURE. 1. Aim/Purpose of this Guideline 1.1
More informationDiabetes How to manage illness
York Teaching Hospital NHS Foundation Trust Diabetes How to manage illness For adults with Type 1 diabetes on a basal bolus insulin regime For more information, please contact: Diabetes and Endocrinology
More informationBlood Glucose - How to test
Blood Glucose - How to test no nurse should use blood glucose monitoring equipment without complete training the ward manager is responsible for ensuring staff are trained in Blood Glucose testing Calibration
More informationPEDIATRIC DIABETIC KETOACIDOSIS
PEDIATRIC DIABETIC KETOACIDOSIS October 2011 Quality Improvement Resources Illinois Emergency Medical Services for Children is a collaborative program between the Illinois Department of Public Health and
More informationP AC K AG E L E AF L E T: INFORMAT I ON FO R THE USER. 500 mg, film-coated tablet Active substance: metformin hydrochloride
P AC K AG E L E AF L E T: INFORMAT I ON FO R THE USER Siofor 500 500 mg, film-coated tablet Active substance: metformin hydrochloride For use in children above 10 years and adults Read all of this leaflet
More informationCORONARY ARTERY BYPASS GRAFT & HEART VALVE SURGERY
CORONARY ARTERY BYPASS GRAFT & HEART VALVE SURGERY www.cpmc.org/learning i learning about your health What to Expect During Your Hospital Stay 1 Our Team: Our cardiac surgery specialty team includes nurses,
More informationSUMMARY OF PRODUCT CHARACTERISTICS. Albuman 200 g/l is a solution containing 200 g/l (20%) of total protein of which at least 95% is human albumin.
Albuman 200 g/l SPC 01 December 2015 SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT Albuman 200 g/l solution for infusion 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Albuman 200 g/l
More informationtips Insulin Pump Users 1 Early detection of insulin deprivation in continuous subcutaneous 2 Population Study of Pediatric Ketoacidosis in Sweden:
tips Top International Publications Selection Insulin Pump Users Early detection of insulin deprivation in continuous subcutaneous insulin infusion-treated Patients with TD Population Study of Pediatric
More informationProtocol for the safe administration of iodinated contrast media in diagnostic radiology
Protocol for the safe administration of iodinated contrast media in diagnostic radiology Protocol statement: This protocol applies to all staff within Radiology Departments at Heart of England NHS Foundation
More information